This effectively dilates the upper
airway, preventing its collapse, thus enabling the patient to assume a normal
breathing pattern which results in an uninterrupted sleep.
It can be extrapolated however, that these issues are also present for the
pediatric patient and, in many cases, are made worse due to the patient's lack of understanding of the therapy and fear of intervention, as well as the commercial
unavailability of a wide variety of sizes or well fitting masks and headgear.
Approximately 20% of patients, for a variety of reasons, never learn to tolerate it and a substantial proportion of the others have a hard time using it regularly.
The statistics for use in pediatric patients can be much worse.
Problems such as mask fit,
pressure sores or redness around the
nose and nasal
dryness or stuffiness are common reasons that patients fail to comply.
Air leaking from around a poorly fitting
nasal mask can be quite uncomfortable and possibly result in suboptimal treatment.
Air leaking causes the generator to blow more air to achieve the prescribed pressure, thus making it more uncomfortable for the patient and possibly causing more arousals during sleep.
For this reason, it is essential that the mask fit properly, which is particularly challenging in the case of children.
Clearly nasal and full-
face masks designed to fit the adult face are unsuitable for these patients, especially in their early years.
Craniofacial abnormalities may add to the difficulty in finding a mask that fits well.
Further, it has been reported that children wearing an improperly fitting mask during
bone development can develop facial abnormalities as a result of the poorly fitting mask.
Often, a suitable component is not available at all and the therapist and patient must “make do” with the closest alternative, which is often uncomfortable and heavy and as a result little used.
Once the
cuff has been
cut to provide a better fit for slightly larger noses or abnormalities, the
cut edges are likely to cause
irritation at the points of contact or leaks where there is insufficient sealing.
Further, the cushioned
forehead support continues to cause
pressure sores, especially in the smallest of the patients where the headgear may not fit adequately and the mask moves about.
For many patients, the flat surface of the mask shell does not permit adequate space for the
nose and as a result the
nose rests against the surface often resulting in
pressure sores.
Many of the pediatric patients are non-compliant and may fall asleep periodically throughout the day and night.
The Velcro™ fasteners are difficult to adjust without arousing the child.
More importantly, if the child has fallen asleep in an awkward position, it is difficult to ensure that the mask is positioned correctly and snuggly on the face, as the length of the straps are dependant on where the fasteners are fastened each and every time the mask is worn.
Placing a mask on the face may elicit fear of the apparatus itself or what it is perceived to be associated with and particularly for those who have become tactile defiant, compliance becomes a struggle that many parents and therapists are unable to resolve.
For some patients, the loss of time may be critical to their overall health and may result in the need to proceed to more conventional invasive techniques such as tracheostomy, without giving the therapy a chance.
The
aerosol mask however, cannot be used to administer CPAP, as it is designed to be
hand held over the nose and mouth for short-term use for
inhalation only, rather than attached to headgear for
continuous use.